Wrist Arthritis Clinical Presentation
- Author: Palaniappan Lakshmanan, MBBS, MS, AFRCS, FRCS(Tr&Orth); Chief Editor: Harris Gellman, MD more...
Patients presenting with osteoarthritis (OA) of the wrist are typically older than 50 years. However, RA and its variants may manifest earlier. Likewise, in patients with previous trauma, secondary OA can appear at a young age.
The predominant symptom of wrist arthritis is pain. In the early stages of wrist arthritis, pain is usually aggravated during the extremes of movement. As the disease progresses, the pain gradually worsens to involve the full, available range of motion.
The range of motion may also gradually deteriorate. OA may progress to such an extent that, in severe cases, the wrist has no movement. However, in rare cases in which the patient has inherent hyperelasticity, as in those with Ehlers-Danlos Syndrome or Marfan Syndrome, the wrist may maintain have good range of motion despite severe degenerative changes. The images below depict a patient with normal range of motion.
Deformity is another feature of wrist arthritis. This is common in RA, in which deformity may be complicated by association with subluxation of the radiocarpal and inferior radioulnar joints. Swelling of the wrist is one of the most common manifestations of RA and may occur because of synovial thickening.
Because the wrist stabilizes the hand for functioning, pain and deformity may result in the loss of such function with weakness of the hand grip. Wrist deformity and instability reduce support for the hand to grasp, impairing dexterity, whereas stiffness and the inability to extend the wrist deprive the fingers of the tenodesis effect.
Attrition rupture of the tendons may occur, specifically when they glide over the rough osteophytes, resulting in loss of function in the fingers. The flexor pollicis longus tendon is prone to such ruptures over the distal pole of the scaphoid; this is called a Mannerfelt lesion.
Cases have been described in the literature in which the flexor pollicis longus, flexor digitorum superficialis, and flexor digitorum profundus tendons to the index finger all are ruptured, with osteophytes at the distal pole of the scaphoid. Likewise, the small and ring finger extensor digitorum communis tendons are prone to attrition ruptures.
Persistent synovitis at the distal radioulnar joint may result in dorsal subluxation of the distal ulna, crepitus during forearm pronation and supination, deformity of the carpus, and rupture of the extensor digitorum communis tendons; this is called caput ulna syndrome. Because the tendons in the flexor and extensor compartments of the wrist have a synovial lining, synovitis of the wrist usually results in tenosynovitis, and may lead to tendon subluxation, adhesion, and, finally, rupture. See image below.
Classic rheumatoid wrist arthritis begins with radial deviation of the wrist, resulting in ulnar head prominence. This progresses to supination and ulnar translation of the carpus, finally leading to volar subluxation of the radiocarpal joint. Crepitus in the wrist becomes more apparent as joint disease progresses.
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